Rare tooth-in-eye surgery restores vision in the blind

For the very first time in Canada, ophthalmic surgeons have performed osteo-odonto keratoprosthesis (OOKP)—better known as “tooth-in-eye surgery”—on three patients with severe corneal blindness due to conjunctival scarring.

The intended eventual outcome: vision restoration.

Do I even need to ask where to begin with this?

We’ll start with the basics of OOKP, which was originally developed in Italy in the 1960s and later modified and reintroduced in Britain in the 1990s.

Here’s a rundown on how this multi-step surgical procedure works:

• A surgeon first extracts one of a patient’s canine teeth, shaves it down and shapes it into a rectangle, drills a hole into it, and then glues a plastic optical lens (implant) inside that hole
• The tooth is then surgically embedded into the patient’s cheek to allow for a layer of tissue to grow around it
• Following this, the surgeon cuts a flap of skin from inside the patient’s cheek that is then surgically attached to the front of the patient’s eye (cornea and sclera).

And that’s it?

For the first phase. The second phase doesn’t start until 3 months later (pending all went well during the first part).

This step involves the surgeon:

• Pulling back that skin flap from the patient’s eye to remove any tissue that was previously damaged (such as the lens and the iris) during past surgeries
• Removing the reshaped tooth from the patient’s cheek and embedding it into the eye
• Sewing the skin flap back over the eye and cutting a small hole for patients to see through

I have to ask: Why use a tooth for this?

A healthy tooth (specifically, a single-root tooth such as a canine) provides stability and a blood supply to the eye.

• Plus: Teeth also have dentine—the hardest substance the body produces—making it the ideal casing to bridge the plastic lens and the patient's eye.

An even bigger added bonus: There is a minimized risk for the implant to be rejected (as observed in standard corneal transplants) because the OOKP is made partly of the patient’s tooth and jaw bone.

So what’s the end result?

Patients’ eyes will have a pink tissue with a black dot in the middle (where the pupil should be).

• See a visual of how this looks—and watch a video of the entire process below.

https://youtu.be/CDpo1ptkgxU

And then patients can see?

Not right away. Ideally, their vision is restored within a month or so of completing the procedure’s second phase.

What’s the realistic expectation?

Previous research reported patients’ vision was restored to a level previously “deemed not possible” and considered good enough for them to drive.

And as other recent reports have noted, they may “have a narrower field of vision, similar to peering through a porthole—but they can usually resume some of the activities they had to stop when they went blind.”

Any more recent data?

This promising outcome was also seen in a 2022 study published in the American Journal of Ophthalmology, in which 59 patients (82 eyes) who underwent OOKP were followed for 30 years.

Among the findings:

• OOKP integrity was maintained in 94% of eyes
• Mean best-corrected visual acuity (BCVA) improved:
  • 2.60 ± 0.32 logMAR at presentation
  • 0.40 ± 0.65 logMAR at 1 year
  • 1.21 ± 1.19 logMAR at 30 years
• 51% of included eyes attained a BCVA better than 0.05 logMAR

Not bad. So who are the target patients for OOKP?

For the most part, patients diagnosed with corneal diseases—specifically end-stage inflammatory corneal diseases—who still have a healthy retina and optic nerve in the back of their eyes and who are not eligible for a conventional corneal transplant.

Included in this category are patients with bilateral corneal blindness resulting from conditions such as (but certainly not limited to):

• Severe end-stage Stevens-Johnson syndrome
• Ocular cicatricial pemphigoid
• Chemical or thermal burns, physical injury (such as fire, liquid aluminum)
• Multiple failed penetrating keratoplasty
• Loss of the lids (Crouzon disease)
• Severe keratitis
• Uveitis
• Graft-versus-host disease

See here for contraindications to the procedure.

Alrighty, let’s circle back to those patients in Canada.

All three patients underwent the first phase of this procedure in February 2025, with each performed by ophthalmologist Greg Moloney, MD, of the Vancouver-based Providence Health Care.

• To note: Funding for these surgeries is provided by the British Columbia-based nonprofit St. Paul’s Hospital Foundation, which raised $430,000 to support the clinic through its first 3 years of operations.

Pending no adverse events (AEs) manifesting over the next few months, the plan is for them to undergo phase two in May and—potentially—restore their vision by mid-year.